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Adv. Clinical Chem
Exam 1 - LFT
| Question | Answer |
|---|---|
| Name 5 functions of the liver. | Protein Synthesis, Metabolism, Detoxification, Storage, and Exretion |
| What does ALP stand for? | Alkaline Phosphatase |
| Where is ALP found? | In the liver, bone, intestines, placenta, and cancer cells. |
| ALP will be 3 to 10 times the upper limit of normal in which diseases? | Obstructive Liver Disease - gallstones or hepatic tumors |
| What is analyzed to determine the source of ALP? | Isoenzymes |
| ALP will be (increased/decreased) in children and the elderly? | Increased - due to bone growth or repair |
| The analysis of isoenzymes is based on what characteristic of each isoenzyme? | temperature denaturation point |
| What is the order of most heat stable to least stable when it comes to the source of ALP? | Placenta > Intestine > Liver > Bone |
| True or false: When differentiating between the Regan or the Nagao ALP isoenzyme,when heated at 65°C for 30 minutes, the Regan isoenzyme will be destroyed. | False- neither will be destroyed at 65 deg C for 30 min unless the appropriate inhibitor is added. |
| What does ALT stand for? | Alanine Aminotransferase |
| An ALP level that is 10 times the ULN represents which diseases? | Primary biliary cirrhosis or congenital atrezia of intrahepatic ducts. |
| An ALP level that is 1 to 3 times the ULN represents which diseases? | Alcoholic liver disease |
| If AST/ALT > ALP, what liver disease is most likely present? | Chronic Active Hepatitis |
| What liver enzyme is the most specific for Liver Function? | ALT |
| True or False: Clinical symptoms will arise before ALT during a viral infection. | False - ALT rises before clinical symptoms, especially in viral infections. |
| AST stands for what? | Aspartate Aminotransferase |
| Fill in the blanks: AST is especially rich in ___________ ____________? | Skeletal muscle |
| AST is increased in which disease states (3)? | AMI, Muscular dystrophy, and kidney damage |
| What is the "sister enzyme" of Alkaline Phosphatase? | Acid Phosphatase |
| When comparing AST and ALT: Which enzyme is most abundant in the liver? | ALT |
| When comparing AST and ALT: Which enzyme shows moderate sensitivity during acute inflammation? | AST |
| The De Ritis Ratio is represented by what equation | AST/ALT |
| What is the De Ritis ratio used for? | To further differentiate between specific liver diseases as to whether they are acute or chronic, and intra-hepatic or extra-hepatic. |
| What is GGT an abbreviation for? | Gamma Glutamyl Transpeptidase |
| Where is GGT found (2)? | In the Liver and Kidney |
| Fill in the blank: GGT is specific for ________ disease. | hepatobiliary |
| Which enzyme is very sensitive to alcohol consumption? | GGT |
| GGT is located where? | Within the membranes of the smooth endoplasmic reticulum. |
| Any substance which causes ___________ ___________ will increase GGT synthesis. | microsomal proliferation |
| In which of the following would you NOT see an increase in GGT? a.Sepsis b.AML c.Neurological Diseases d.Liver Disease | b. AML |
| Fill in the blank: __________ is the colorless end product of bilirubin metabolism. | Urobilinogen |
| What is the amount(%) of direct bilirubin within circulation? | Approximately 20% |
| High levels of what substance is found within hemolytic disease? | Urobilinogen |
| During biliary obstruction, you would find (increased/decreased) levels of urobilinogen. | Decreased |
| What is the common name for hemolytic icterus? | Pre-hepatic Jaundice |
| Pre-hepatic jaundice is characterized by increased (conjugated/unconjugated) bilirubin. | Unconjugated |
| Pre-hepatic jaundice within the newborn is also known as __________ jaundice. | Physiologic |
| What is the reason that 50% of newborns are born with physiologic jaundice? | Immature liver function |
| What is a concern with transcutaneous bilirubinometry? | High levels may be inaccurate depending on the race of the baby |
| Fill in the blank: Hemolytic icterus arises when excessive _________ is presented to the liver for metabolism. | bilirubin |
| Fill in the blank: Hepatic Jaundice is also known as ________ _______. | Toxic Icterus |
| True or False: Gilbert's Syndrome involves impaired cellular uptake. | True |
| What would you expect to find in increased levels in Gilbert's Syndrome? | Unconjugated (<3mg/dL) and total bilirubin |
| What is the role of the enzyme UDPG-T? | This enzyme conjugates bilirubin |
| True or false: Crigler-Nijjar Syndrome Type II results from complete absence of UDPG-T enzyme. | False - Type I results from complete absence of the UDPG-T enzyme while Type II results from a deficiency of the enzyme. |
| Fill in the blank: ___________ results from excess bilirubin deposits within the brain and leads to death. | Kernicterus |
| Dubin-Johnson Syndrome results from what? | Defective excretion of bilirubin into the bile. |
| Is Dubin-Johnson Syndrome acquired or genetically linked? | Genetically linked |
| In Dubin-Johnson Syndrome, what is the predominant from of bilirubin? | Conjugated |
| Fill in the blank: Post-hepatic jaundice is caused by impaired __________ of bilirubin from the blood | Excretion |
| Is post-hepatic jaundice a kidney problem? | No, the function of the kidney is normal. |
| What is the cause of post-hepatic jaundice? | Mechanical obstruction of bile flow into the GI tract. |
| Fill in the blank: In post-hepatic jaundice, you would expect to see ________ conjugated bilirubin and ________ urobilinogen. | Increased conjugated bilirubin and Decreased urobilinogen |
| How would you expect the stool to appear within a patient who has post-hepatic jaundice? | clay colored or chalky white |
| Reyes Syndrome is present in which specific population? | Children ages 6 - 12 years old |
| Which unique compound is seen in elevated levels in Reyes Syndrome? | NH3 (Ammonia) |
| True or False: Reyes Syndrome is treated with aspirin? | False - Reyes Syndrome is worsened by Aspirin |
| A patient exhibiting symptoms of Reyes Syndrome will also be (hypo/hyper)glycemic. | Hypoglycemic |
| The excretion of bile is affected in which disease? | Cholestasis |
| Fill in the blank: Defective liver cell function is a cause of ___________ cholestasis. | Intrahepatic |
| Fill in the blank: In Wilson's Disease, __________ is deposited within the brain, liver, kidney, and cornea. | Copper (Cu+) |
| Neurological degeneration and Kayser-Fleischer rings are present in what disease? | Wilson's Disease |
| Ceruloplasmin is (increased/decreased) in Wilson's Disease? | Decreased |
| What are 3 hepatic manifestations seen in Wilson's Disease? | Hepatomegaly, Subacute or Chronic Hepatitis, and Cirrhosis of the liver. |
| ACP stands for what? | Acid Phosphatase |
| Which liver enzyme is used to detect prostate cancer? | ACP |
| Fill in the blank: ALP requires a pH of ____ in order to be measured, while ACP requires a pH of ____. | ALP needs a pH of 10; ACP needs a pH of 5.4 |
| 5’ Nucleotidase is found within which organ(s)? | The liver |
| In hepatobiliary disease, 5' Nucleotidase in (increased/decreased) | Increased |
| The major sources of Aldolase are found within the _________ and __________. | Skeletal muscle and heart |
| In Duchenne type muscular dystrophy, 10-50 times the ULN can be found of which enzyme? | Aldolase |
| True or False: Adolase is not very often used as a diagnostic tool. | True |
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UTHSCSA-CLS
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